What to know about the Long-Term Care Ombudsman program

If you ever want to really appreciate your life, picture yourself being moved to a place you had never been before, having few or no visitors, feeling that the care you were receiving was at best substandard, and being afraid to complain because of possible retaliation.  Fortunately the vast majority of skilled nursing facilities do provide proper levels of care now for their residents, but what if that is not the case for you or a friend or loved one?

In earlier posts I have written about my experience volunteering with the Long-Term Care Ombudsman Program of Ventura County, California.  The value of this program, which advocates for the rights of residents in long-term care facilities (skilled nursing homes, 6-bed/board and care homes and assisted living homes) cannot be overstated.  Sadly many congregate living facility residents have no one to advocate for them if they are faced with poor care or even abuse.

The definition of a Long-Term Care Ombudsman is an advocate for residents of nursing homes, board and care homes, and assisted living facilities.  These advocates can provide information regarding how to select a facility and what to do to get quality care.  They are trained to resolve problems – both major and minor.  They represent the perspective of residents in monitoring laws, regulations and policies.  Ombudsman programs promote policies and consumer protections to improve long-term services and supports at the facility, local, state, and national levels.

Federal law requires each state to have a LTCOP headed by a State Long-Term Care Ombudsman.  In many states residents are served  by a combination of paid staff and highly trained and certified volunteers.

The beginnings of the Medicare and Medicaid programs in 1965 provided the groundwork for the nursing home industry that we have today.  Before these programs, there was no public money to provide an incentive for private owners/companies to build facilities and this brought about tremendous growth in the number of nursing/care homes in the US.

Many articles in the late 1960’s and early 1970’s were written about abuse, neglect and substandard conditions found in SNF’s (skilled nursing facilities).  Several Congressional committees were started to hear testimony, compile data and propose reforms for the nursing home industry.

Consumer advocate Ralph Nader in 1970 put out a notable report, “Old Age: The Last Segregation,” which was a catalyst for public action on the care or lack of care provided in SNFs.  Gerontologist Robert Butler reported on two cases of poor care resulting in resident deaths.  One involved carpeting in a facility that allowed 32 of 46 residents to die in 1970 from asphyxiation from acrid smoke in a fire.  Another involved a salmonella food poisoning epidemic, which took the lives of 12 residents after delays in requesting medical help. The owner of that home complained about the attention being paid to this story by the media by saying “is it really that big?”

In 1971 President Nixon formulated an eight-point nursing home program.  The 6th point in his program was assistance for state investigative “Ombudsman” units.  Dr. Arthur S. Flemming, Counselor to President Nixon, developed the idea of the ombudsman program.  He envisioned the program as an advocacy program for residents and personally wrote its first guidelines.  The LTCOP was initiated to improve the quality of care in America’ nursing homes and to respond to complaints submitted to the White House and Department of HEW about abuse and neglect of nursing home residents.

Begun in 1972 as a demonstration program, today the Ombudsman program operates in all states, the District of Columbia, Puerto Rico and Guam under the authorization of the Older Americans Act.  The 1978 Amendments to the OAA elevated the Nursing Home Ombudsman Program to a statutory level.  The 1987 Amendments to the OAA resulted in these significant improvements to the program allowing them to advocate more effectively for residents of LTC facilities:

– Required access for Ombudsmen to residents and residents’ records

– Immunity  for Ombudsmen for the good faith performance of their duties

– Prohibition of willful interference with the official duties of an ombudsman and/or retaliation against an ombudsman, resident or other individual for assisting the ombudsman in performance of their duties.

Data for federal fiscal year 2017 from the National Ombudsman Reporting System (NORS)indicate that there were over 1300 full-time-equivalent staff and 6625 volunteers trained and designated to investigate and resolve complaints resulting in the following:

– Worked to resolve 201,460 complaints initiated by residents, their families and others

– Resolved or partially resolved 73% of complaints to the resident’s/complainant’s satisfaction

– Provided 420,000 instances of information and assistance to individuals

– Participated in 21,211 resident council and 1,788 family council meetings

The LTCOP Program has been expanded to advocate for residents in not only skilled nursing facilities but also board and cares and assisted living communities.

The five most frequent complaints in board and care, assisted living, and other residential care communities handled by the Ombudsman program were:

– Improper eviction or inadequate discharge/planning

– Administration and organization of medications

– Quality, quantity, variety and choice of food

– Lack of respect for residents, poor staff attitudes and

– Building or equipment in disrepair or hazardous

The five most frequent nursing home complaints handled by the Ombudsman program were:

– Improper eviction or inadequate discharge/planning

– Unanswered requests for assistance

– Lack of respect for residents, poor staff attitudes

– Administration and organization of medications, and

– Quality of life, specifically resident/roommate conflicts

The Long-Term Care Ombudsman Program is unique in its purpose and the scope of issues it addresses.  Ombudsman programs are designed and directed by law to provide a ideal program of advocacy services for residents.  Continuation of strong national, state, and local Ombudsman programs is critical to help resolve problems so that residents’ needs are met, to help ensure that changes are made when necessary in facility care delivery and to provide information to providers, agencies, legislators and the public about serious flaws in our care system and to help correct them.

I was lucky to find our local Ventura County CA Ombudsman Program after retirement when I was looking for a volunteer opportunity.  I have personally seen the life-changing differences made by the Ombudsmen I have worked with for the past 14 years to improve the day-to-day lives of care facility residents.  These residents are among the most vulnerable in our country.  If you have concerns about the care being provided to someone you know or in a facility in your area, please contact your state LTCOP office (often through your state’s Department of Aging) or your local Area Agency on Aging.